Medicaid coverage of nicotine replacement therapies and medications is associated with 1.6 percentage point reduction in smoking before pregnancy among women with Medicaid relative to those without such benefits.

Adding counseling coverage to nicotine replacement therapies and medication coverage is associated with a 2.5 percentage point reduction in smoking before pregnancy.

Medicaid cessation coverage during pregnancy was associated with a small increase (<1 day) in infant gestation.

Most importantly, Medicaid smoking cessation coverage only had an effect for women enrolled in Medicaid before they were pregnant, when they were childless adults who would not have been covered in most states. The finding is significant because tobacco cessation coverage is one of the Essential Health Benefits (EHB) without co-pays for people who enroll in Qualified Health Plans (QHP) on the exchanges and in Medicaid. In the authors’ words:

“Expansions of Medicaid eligibility to include more women prior to pregnancy in participating states, and mandated coverage of some cessation services without co-pays under the Affordable Care Act (ACA) should reduce the number of women smoking before pregnancy.”

Meanwhile, many states will likely reduce optional Medicaid coverage for adults where Medicaid coverage overlaps with new federally subsidized coverage in Exchanges. This would reduce state spending and streamline program eligibility. Also, ACA is expected to cause some workers – about 8 million, according conservative estimates by the Congressional Budget Office (CBO) – to lose employer-sponsored health insurance. Many of these folks will move to taxpayer funded coverage in Medicaid or Exchanges.

Some 26 states have chosen to not run their own Health Insurance Exchanges, but residents to those states will still have access to a federally run exchange. In some other states, the Exchange will be jointly operated by CMS and the state. Therefore, every individual eligible for new federally subsidized coverage will have an Exchange (called a Marketplace by CMS and some states) to use in applying for coverage and selecting a plan.

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The Piper Report blog on healthcare business and policy covers issues in Medicaid, Medicare, and the Affordable Care Act, with articles, interviews, resources, primers, book reviews, and more. Edited by Kip Piper, MA, FACHE.